Sustainably Improving Neurosurgical Patient Outcomes in Uganda (2020-2021)

Background

Global surgery was catapulted into the global health spotlight with the publication of the Lancet Commission on Global Surgery Report. The report discusses the importance of projects that focus not only on the provision of surgical procedures but also on the need for holistic health systems strengthening.

Since 2007, Duke’s Division of Global Neurosurgery and Neurology (DGNN) has been utilizing this concept to improve neurosurgical care for patients throughout Uganda. DGNN’s approach consists of the provision of neurosurgical services, training (neurosurgery residents, nurses, biomedical engineers), research, partnership and advocacy. The long-term vision includes reaching a threshold of 50 Uganda-trained neurosurgeons who are equitably spread across the country, increasing the number of facilities capable of providing neurosurgical operations, improving the infrastructure for neurosurgical care delivery and developing a Uganda Neuroscience Institute to serve as a center of neurosurgical and neurological excellence within East Africa.

Project Description

Previous teams have identified and quantified issues impacting neurosurgical outcomes, developed and implemented interventions to address these issues, then evaluated and refined the interventions. Building on this work, the 2020-2021 team will determine ways to sustain improvements in outcomes of neurosurgery patients.

In order to develop a sustainable model for improving neurosurgery patient outcomes, the team will focus on three strategic areas.

  • Infection control: How do you develop a lasting culture of hand hygiene and sanitization that helps curb overall infection rates?
  • Medication management: How do you develop a system that ensures that all patients get the right medication at the right time and for the right reason?
  • Patient caretaker education: How do you ensure that patient caretakers are provided with sufficient information to care for their patients to prevent poor outcomes?

Team members will create a sustainability plan for each strategic area and develop an in-country quality improvement team that will pick up this work in the future, ultimately allowing medical facilities in Uganda to maintain the safety standards developed by the team.

In additional, the team will generate data to be used to develop more ways to improve interventions, an abstract for conferences and a manuscript for global health journals.

Anticipated Outputs

Sustainability plan for interventions; plan for Uganda-based quality improvement team; data for developing ways to improve interventions; abstract for submission to conferences; manuscript for submission to journals

Student Opportunities

Ideally, this project team will be comprised of 3 graduate students and 9 undergraduate students. Team leaders seek students in biomedical engineering, global health and medicine, among other areas. Students interested in program evaluation and improvement, with a desire to work in a low-resource setting or a passion for surgical care, would be best suited for this project. Prospective team members should anticipate working within health systems and larger research groups, thus gaining insights in and exposure to these groups.

Students can expect to gain an understanding of ethical issues surrounding global health and global surgery efforts as well as the complexity of the healthcare system in Uganda. The hands-on work will teach students how to conduct health systems strengthening work in low- and middle-income countries by developing a research program to implement and analyze through qualitative and quantitative methods. Additionally, students will learn about the IRB process and eventually write their own IRB. Other versatile skills that students will develop are presentation, manuscript writing, mentoring, poster-making and development of figures and tables.

A student will be selected to serve as project manager.

In Fall 2020, the team will meet every other Friday from 6:00-8:00 p.m.

There is an opportunity for students on the team to travel to Kampala, Uganda, in Summer 2020. While all students are encouraged to travel with the team, the summer component is not required. The summer research will take place over a period of approximately 4 weeks from mid-July to mid-August, with 6-8 hours of work per day for 5 days per week.

Timing

Summer 2020 – Spring 2021

  • Summer 2020 (optional): Development of key ideas for evaluation plans; project development; identification of key improvement areas; travel to Uganda
  • Fall 2020: Project and research implementation and completion
  • Spring 2021: Submission of abstracts, posters and manuscripts; evaluation of project and research data

Crediting

Independent study credit available for fall and spring semesters; summer funding available

See earlier related team, Benchmarking Interventions Aimed at Improving Neurosurgical Patient Outcomes in Uganda (2019-2020).

Hospital.

Team Leaders

  • Anthony Fuller, School of Medicine-Neurosurgery
  • Michael Haglund, Duke Global Health Institute|School of Medicine-Neurosurgery

/graduate Team Members

  • Veronica Brtek, Global Health - MSc
  • Suzanna Joseph, Medicine-MD
  • Bruno Valan, Medicine-MD

/undergraduate Team Members

  • Stephan Beauge, Neuroscience (AB)
  • /undergraduate
  • Taylor Horowitz, Neuroscience (BS)
  • Amina Mohamed, Public Policy Studies (AB), Global Health (AB2)
  • Leena Mohamedali
  • Rifah Nanjiba, Neuroscience (BS)
  • Oluwaseun Oguntunmibi, Neuroscience (AB)
  • Maria Pita, Cultural Anthropology (AB)
  • Elora Pradhan, Biomedical Engineering (BSE)
  • Priyanka Rao, Neuroscience (BS)
  • Jein Seo, Biology (BS), Global Health (AB2)
  • Jonah Sinclair, Neuroscience (BS)
  • Venkat Vege, Chemistry (BS)

/yfaculty/staff Team Members

  • Timothy Dunn, Arts & Sciences-Statistical Science

/zcommunity Team Members

  • Ruth Kange, Mulago Hospital, Neurosurgery Department
  • Michael Muhumuza, Department of Neurosurgery, Mulago Hospital (Uganda)
  • Christine Muhumuza, Department of Public Health, Makerere University (Uganda)
  • Shem Opolot, N/A